The Trump administration should preserve PEPFAR, a program that supports global health and bolsters U.S. interests.

F or the past several decades, HIV/AIDS has devastated sub-Saharan Africa and the Caribbean. Unlike in the United States, where the epidemic was primarily concentrated in specific high-risk groups, these regions faced a generalized epidemic. The virus spread widely across entire populations, and young adults in their 20s and 30s experienced some of the highest mortality rates. This left many children growing up without parents, straining families, communities, and national infrastructure.

The toll of the epidemic extended far beyond individual loss. Without treatment, entire sectors of society were destabilized — security forces, health-care workers, and educators all suffered massive losses. The disappearance of men from security roles and of parents from civilian life contributed to a rise in child soldiers, weakened government institutions, and, as the workforce shrank, slowed economic development.

Meanwhile, antiretroviral therapy (ART) transformed HIV from a death sentence into a manageable chronic disease. But in the early 2000s, access to this treatment depended on widespread testing and robust health-care delivery systems — resources that many countries lacked.

The turning point came in 2003 with the launch of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), created by President George W. Bush as part of the U.S. Agency for International Development. PEPFAR remains the largest commitment by any nation to combat a single disease, and its impact was transformative. It is widely believed that 26 million people are alive today who wouldn’t be were it not for PEPFAR.

Unfortunately, with the Department of Government Efficiency (DOGE) unilaterally gutting USAID in recent weeks, public health and geopolitical experts are scrambling to make sense of de facto abandonment of this highly productive program. President Trump, who is remaking foreign assistance to fit his policy priorities, should immediately call for completely resurrecting PEPFAR and restoring federal operations that support it, not only for the sake of vulnerable people across the globe but also for the benefit of America’s national interests.

For more than 20 years, PEPFAR provided a full continuum of HIV-related services that were otherwise inaccessible in many partner countries. It implemented HIV testing and counseling, supporting the rollout of rapid HIV tests across clinics, community sites, and mobile units. Millions of people were tested, many for the first time, enabling earlier diagnosis and treatment.

It also delivered free or subsidized ART to more than 20 million people. The program supported procurement and distribution systems to ensure a consistent supply of medicines, which doctors and epidemiologists understand is utterly crucial to ensuring better health outcomes and mitigating the spread of deadly disease.

PEPFAR was also indispensable in the prevention of mother-to-child transmission. It funded prenatal services that tested pregnant women, supplied ART to HIV-positive mothers, and greatly reduced the rate of infant HIV infections. These saved tens of millions of children who would have, without PEPFAR programming, been born with the disease.

To improve the delivery of care, PEPFAR funded the expansion of lab networks, including viral-load testing and CD4-testing infrastructure, which allowed providers to be more responsive to patient needs. It also featured community outreach and support services, underwriting case managers, peer navigators, and local nonprofit organizations to engage people living with HIV and reduce the stigma around diagnosis.

PEPFAR was grounded in sustainability, aiming to put countries on a path of understanding and managing their own health crises. It trained tens of thousands of doctors, nurses, and community health workers in the developing world, giving them vital HIV-care knowledge and spurring self-sufficiency within their own medical systems. If the goal of the foreign aid community is to ultimately put itself out of business because it has so succeeded that demand for its services has evaporated, PEPFAR is surely an example of the merits of this philosophy.

Thanks to PEPFAR, all-cause adult mortality in partner countries fell sharply. In 2003, 2.3 million people in sub-Saharan Africa died of AIDS-related illnesses. In the years following PEPFAR’s implementation, adult HIV deaths diminished significantly — by nearly 40 percent between 2005 and 2010 in focus countries. Among 25- to 44-year-olds, the backbone of national workforces, the decline in mortality was especially steep.

PEPFAR was more than a health program; it was a strategic investment in global stability. As President Bush said in his 2003 State of the Union address, “This disease can undermine the economic and social stability of nations and is a grave and growing danger to our security and the stability of the world.”

By cultivating health systems and preserving adult populations, PEPFAR helped maintain internal security in fragile states, reduced the risk of regional conflict, and prevented humanitarian disasters that often require costly emergency interventions. It also safeguarded global markets — especially in regions rich in oil, minerals, and agricultural exports — by protecting the labor forces that sustain them.

It also helped to orient developing nations toward the United States. Absent American influence, these countries would desperately turn to our adversaries, including China and Russia, who are ever eager to compel these populations to back their economic and military expansions.

Perhaps most important, PEPFAR illustrated that proactive investment in global health prevents pandemics before they begin. As we’ve seen with HIV, Ebola, Covid-19, and avian flu, diseases can leap continents with alarming speed in an era of unprecedented global interconnectivity. Health crises abroad can quickly become security threats at home.

Programs like PEPFAR do more than save lives. They strengthen allies, foster democracy, and create stable environments where education and economic opportunity can thrive. With infinitesimal taxpayer investment, we can support the very foundations of a more secure and prosperous world.